Patient has low chance of spreading TB

[June 06, 2007]  DENVER (AP) -- The Atlanta lawyer quarantined with a dangerous strain of tuberculosis has a relatively low chance of spreading the disease, possibly allowing him to leave his isolation room for a short time as soon as next week, one of his doctors said Tuesday.

A third test of Andrew Speaker's sputum -- a mixture of saliva and phlegm -- turned up negative for the presence of TB bacteria, confirming the results of earlier tests at National Jewish Medical and Research Center.

Normally, TB patients with three negative sputum tests who have undergone at least two weeks of treatment are allowed to leave their isolation rooms briefly as long as they wear a mask. Additional precautions are advised for patients, like Speaker, with drug-resistant strains of the disease.

If his drug regimen is established and if he wears a face mask, Speaker could be allowed outside on hospital grounds with an escort as early as next week, said Dr. Charles Daley at a news conference.

"I think it's important for people's treatment ... to get outside," Daley said.

However, given the attention Speaker's case has attracted, Daley said it's possible hospital officials or Speaker himself could decide against outside walks to protect his privacy.

Doctors could decide as early as this week whether Speaker should undergo surgery to remove infected tissue, Daley said.

Doctors are hopeful Speaker's tuberculosis can be cured because it is not widespread, he is otherwise healthy and young, and National Jewish has extensive experience treating drug-resistant infections with a combination of drugs and surgery.

Speaker, 31, originally was found to have multidrug-resistant TB, which can withstand two mainline drugs used to treat tuberculosis. While he was in Europe on his honeymoon last month, tests revealed he had extensive drug-resistant tuberculosis, or XDR-TB, which can withstand more drugs.

Both houses of Congress have scheduled hearings for Wednesday morning to assess how the Centers for Disease Control and Prevention and other federal agencies handled the situation.

After Speaker learned of the more serious diagnosis, he took commercial flights to Canada and drove into the United States. He says that before he left the United States, officials did not order him that he should not to fly.

A border officer at the Champlain, N.Y., crossing has been reassigned and is under investigation for ignoring a computer alert about Speaker, which contained instructions to detain him, don protective gear and call public health authorities.

Under new rules being adopted, individual Customs officers will no longer be able to override instructions to detain someone like Speaker. They would have to get approval from a supervisor, according to a Department of Homeland Security official who spoke on condition of anonymity because no formal announcement had been made.

Doctors in Denver continue to perform tests on Speaker. A smear test is one way to test for the presence of TB bacteria and requires patients to inhale an irritating salt water solution, producing a deep cough. Their sputum is then smeared on a slide and placed under a microscope.

A negative result means there were no germs visible. But a culture test of Speaker's sputum -- considered the "gold standard" in TB testing -- has yielded TB bacteria.

Hospital spokesman William Allstetter cautioned that a patient with a negative smear test could still have TB bacteria in his sputum, and cited a recent study suggesting that 20 percent of new TB cases could be traced back to contact with smear-negative patients.

Tuberculosis is transmitted by air in nearly all cases. Active TB patients normally cough, dispersing particles that can float in the air for hours. Speaker does not have a cough, Allstetter said.

Health authorities are still trying to contact passengers and crew members who were aboard two trans-Atlantic flights with Speaker last month to advise them to undergo TB testing.

Montana health officials said Tuesday that they were testing and monitoring someone who may have been exposed on a flight, but that they could not identify the person because of confidentiality laws.

Speaker's strain has so far resisted at least 10 of 14 drugs available for treating TB, according to Dr. Michael Iseman of National Jewish. Surgery to remove infected lung tissue, about the size of a tennis ball, is one option. The infection's relatively small size increases the chances of success of surgery.

On Tuesday, Dr. Mario Raviglione of the World Health Organization said there were only two drugs that are effective against Speaker's strain.

Daley declined to comment on Raviglione's remark but said National Jewish could use five or six drugs on Speaker that aren't normally used to treat TB, a common practice with previous drug-resistant patients.

[Text copied from Associated Press file. Associated Press writer Devlin Barrett in Washington contributed to this report.]